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This leads to quick changes "from one pathological posture to another": this is very different from the adult, whose pathological picture may be recognized and worked with. The difficulty of engaging adolescent patients in treatment is compared by Anna Freud to patients in mourning or in love: because their libido is invested in a real person, available or just lost, little libido is left to invest in the analyst. After a detailed analysis of various defence presentations, Anna Freud stresses that it is normal for youngsters to waver in their struggles with their impulses and the constraints of their consciences.

Difficulties in facing and working through these changes can sometimes lead to intense feelings of despair and hopelessness, which can, in turn, bring about the belief that death is the only possible solution to these conflicts. What do we mean by death? Conscious thoughts about death are not infrequent in adolescence. Most adolescents entertain, at some point or other, the wish to kill themselves, to disappear, to see their parents dead. In his work Thoughts on War and Death, Freud (1915) says: It is indeed impossible to imagine our own death; and whenever we attempt to do so we can perceive that we are in fad stiU present as spectators.

When treating these adolescents, the analyst usually is left, as I was with Sally, with the feeling that one has to wait not knowing, and to be able to bear not knowing whether they are going to kill themselves or not, but without giving up hope. The therapist's hopelessness about the possibility of helping these adolescents can be experienced in the same way that Sally experienced her friends-that one is turning against them and confirming their belief that their hatred makes them totally unworthy of love.